Overview and CQC Inspections

Our inspector's description of this service

Last updated 14 January 2014

University College London Hospital is an acute hospital run by the University College Hospitals NHS Foundation Trust. It is located in central London and provides acute and specialist services to the local populations of the London Boroughs of Camden, Islington, Barnet, Haringey and Westminster as well as patients from further afield. It has a total of 650 beds and serves a population of 1.3 million people. The hospital includes the Elizabeth Garrett Anderson (EGA) Maternity Wing, and Macmillan Cancer Centre.

The trust also provides specialist services at the Hospital for Tropical Diseases, the Royal National Throat, Nose and Ear Hospital, the National Hospital for Neurology and Neurosurgery, the Royal London Hospital for Integrated Medicine, the Heart Hospital and the Eastman Dental Hospital. It was one of the first to gain foundation trust status.

Our focus on this inspection was on University College London Hospital as part of our acute hospital inspection programme. We did not inspect the specialist services.

We chose to inspect University College London Hospital as one of the Chief Inspector of Hospital’s first new inspections because we were keen to visit a range of different types of hospital varying from those considered to be high risk of poor care to those where the risk of poor care was judged to be lower. University College Hospital was considered to be a low risk provider. It has been visited by CQC five times since it was registered in October 2010 and has always been assessed as meeting the standards of care set out in legislation.

Our inspection team included CQC managers, inspectors and analysts as well as doctors, nurses, allied health professionals, a pharmacist, senior midwife, patient representatives and people who have used services (Experts by Experience) as well as senior NHS managers. The team spent three days visiting the hospital and conducted further unannounced visits six and seven days afterwards. We held a public listening event in Camden and heard directly from 30 people about their experiences of care.

Our analysis of data from CQC’s ‘Intelligent Monitoring’ system before the visit indicated that the trust was operating safely and effectively across all services. The trust’s mortality rates were as expected or better than expected for a trust of its type and size.

We found that, generally, services were safe, effective, caring, responsive to patients’ needs and well-led. When we inspected we saw many examples of good care. We were impressed by the dedication of the doctors and nurses we saw and the level of support that they were given as well as the mutual respect shown within teams, leading to high levels of care. We were also impressed with the emphasis placed at all levels from the trust’s board and governors down to ward level on putting the needs of patients first.

The vast majority of patients we spoke to at University College Hospital were very positive about the care they received. Many members of staff told us that they felt well supported by senior clinical staff who responded quickly to requests for help. Staff told us they were proud to work at the trust and proud of the level of care they were able to deliver.

It has a stable and experienced board and the trust’s Governors act very much as patient champions, providing challenge. There is a clear governance structure based in clinical divisions but with a corporate overlay and this has resulted in high levels of care being developed and maintained.

We wish to emphasise here some of the many good aspects of care we saw being delivered at this hospital,including:

The commitment of staff in A&E to delivering good care

In Medical Care, examples of excellent caring staff, well supported, with good care and positive interaction with patients.

In Surgery examples of excellent care, support for patients’ needs and a strong consultant presence.

In Intensive/Critical care, examples of caring efficient staff showing good multi-disciplinary working with good clinical outcomes.

Maternity services that overall were safe, caring, effective, responsive and well –led.

In Children’s care a strong collaborative style of working for the benefit of children, young people and their families.

We did however note areas of the hospital where staff were delivering care under pressure and where the environment was less good:

In A&E we found that staff, to their credit, were delivering safe care but in very difficult circumstances. The physical environment was inadequate. Due to shortage of space, facilities and equipment and patients’ privacy and dignity was severely compromised. We also found that the emphasis on receiving large numbers of patients through A&E instead of direct to an appropriate receiving clinical area was making the situation worse.In failing to address these issues we found trust leadership in A&E needed to be strengthened and improved. We believe the trust should take action to alleviate those pressures.

We found a risk of unsafe surgery as the World Health Organisation (WHO) surgical safety checklist was not always fully completed.

On medical wards, we were concerned about written nursing assessments, care plans and care delivery records being insufficiently completed. Although we saw no evidence of unsafe care being delivered, insufficient recording meant there was an increased risk of inappropriate or unsafe care or treatment.

The management of outpatient clinic was not adequate resulting in overcrowding and patients being left without seating in busy periods.

During our visit we became aware that the trust may not be recording its cases of hospital acquired infection in accordance with national guidelines. We raised this with the trust at our inspection. It is currently in discussion with Public Health England on this issue.

The trust was not ensuring that the paperwork for patients who had been assessed as not requiring resuscitation was always fully completed.

Inspection checks

These checks were carried out under the inspection model we've used since 2009. These will gradually be replaced by our new ratings (see right).

All standards were being met when we inspected the service. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

At least one standard in this area was not being met when we inspected the service and we required improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.

New inspection ratings

We're moving to our new inspection model and rate services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good - the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.